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Class of Patients Fights Aetna Policy Change on Health Insurance

SAN DIEGO (CN) - Aetna on Jan. 1 will force customers with HIV or AIDS to buy medicine from a subsidiary or pay thousands of dollars or more each month, a class action claims in Federal Court.

John Doe et al. sued Aetna, Aetna Healthcare, and Aetna Specialty Pharmacy on Dec. 19. They also claim that the new policy will invade their privacy.

According to the 65-page lawsuit, Aetna enrollees as of Jan. 1 will be "required to obtain their specialty medications to treat HIV/AIDS and other serious illnesses from ASP, a wholly-owned subsidiary of Aetna."

ASP delivers medications only by mail, threatening the privacy of HIV and AIDS patients, the class claims.

"Class members who live in apartment buildings or will be required to have medications delivered to their work place have expressed alarm that neighbors and co-workers, who do not know that the recipient has HIV/AIDS, will come to suspect that they are ill," the lawsuit states. "Mail-order shipments also present the risk of lost or stolen medications, as each shipment of medications may be worth thousands of dollars."

Also, enrollees will be forced to obtain medications based on the schedule of the delivery person, as the recipient must be present when the package arrives, the complaint adds.

Patients who continue to use their community pharmacy "must pay thousands of dollars or more each month to purchase their medications at their community pharmacy (hereafter, the 'program')," the lawsuit states. "The dramatic cost increase is the result of Aetna's reduction in health plan benefits effectuated by transforming drug purchases at community pharmacies from an 'in-network' covered benefit to an 'out-of-network' payment."

If enrollees choose to have their medications delivered, they say they will suffer a 20 percent co-insurance charge of up to $150 per prescription. Before the change, enrollees paid a fixed amount of $20-$70 per prescription.

"For all but the wealthiest HIV/AIDS patients, such dramatic cost increases are untenable and thus many class members are left with no choice but to risk their health and privacy by obtaining their life-sustaining medications by mail," the complaint states.

According to the class, Aetna's new policy does not allow for early deliveries.

"If there are circumstances that make it difficult for the patient to re-order drugs at the time - for the example, workload, travel, illness - or if there are any processing or mail delays, HIV/AIDS patients will likely miss doses and potentially experience serious health problems as a result," the lawsuit claims.

The mail program is further flawed because enrollees can't transfer all of their medications to the program. "Instead, the mail-order program is limited exclusively to specialty medications, requiring the patient to manage prescriptions between several locations and bounce between their community pharmacy and receiving their mail-order deliveries," according to the lawsuit.

The class claims Aetna will profit by keeping hundreds of thousands of dollars in prescription fill fees to itself.

Doe seeks class certification, restitution, and wants Aetna and its subsidiaries enjoined from implementing the program.

He is represented by Edith Kallas of Whatley Kallas in New York City.


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